دورية أكاديمية
أعرض في EDS

Evaluation of Dosing Strategies of N-acetylcysteine for Acetaminophen Toxicity in Patients Greater than 100 Kilograms: Should the Dosage Cap Be Used?

التفاصيل البيبلوغرافية
العنوان: Evaluation of Dosing Strategies of N-acetylcysteine for Acetaminophen Toxicity in Patients Greater than 100 Kilograms: Should the Dosage Cap Be Used?
المؤلفون: Baum RA; Department of Pharmacy Services, University of Kentucky HealthCare, 800 Rose Street, H112, Lexington, KY, 40536-2093, USA. rabaum2@uky.edu., Woolum JA; Department of Pharmacy Services, University of Kentucky HealthCare, 800 Rose Street, H112, Lexington, KY, 40536-2093, USA., Bailey AM; Department of Pharmacy Services, University of Kentucky HealthCare, 800 Rose Street, H112, Lexington, KY, 40536-2093, USA., Howell MM; Pharmacy Department, Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN, 46202, USA., Weant KA; Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina 715 Sumter Street - CLS, Columbia, SC, 29208, USA., Geraghty L; Department of Pharmacy, Norton Cancer Institute, 676 South Floyd Street, Louisville, Kentucky, 40202, USA., Mohan S; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 462 First Avenue, Room A340A, New York, NY, 10016, USA.; New York City Poison Control Center, 455 1st Avenue, Room 123, New York, NY, 10016, USA., Webb AN; Kentucky Poison Control Center, Norton Children's Hospital, PO Box 35070, Louisville, KY, 40232-5070, USA., Su MK; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 462 First Avenue, Room A340A, New York, NY, 10016, USA.; New York City Poison Control Center, 455 1st Avenue, Room 123, New York, NY, 10016, USA., Akpunonu P; Kentucky Poison Control Center, Norton Children's Hospital, PO Box 35070, Louisville, KY, 40232-5070, USA.; Department of Emergency Medicine, University of Kentucky-Chandler Medical Center, 800 Rose Street, Lexington, KY, USA.
مؤلفون مشاركون: Collaborators
المصدر: Journal of medical toxicology : official journal of the American College of Medical Toxicology [J Med Toxicol] 2021 Jul; Vol. 17 (3), pp. 241-249. Date of Electronic Publication: 2021 Apr 21.
نوع المنشور: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: United States NLM ID: 101284598 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1937-6995 (Electronic) Linking ISSN: 15569039 NLM ISO Abbreviation: J Med Toxicol Subsets: MEDLINE
أسماء مطبوعة: Publication: 2010- : New York : Springer
Original Publication: Philadelphia, Pa. : University of Pennsylvania Press, c2005-
مواضيع طبية MeSH: Dose-Response Relationship, Drug* , Obesity*, Acetaminophen/*toxicity , Acetylcysteine/*therapeutic use , Analgesics, Non-Narcotic/*toxicity , Chemical and Drug Induced Liver Injury/*drug therapy , Free Radical Scavengers/*therapeutic use, Adult ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies
مستخلص: Introduction: Acetaminophen is a commonly used analgesic and antipyretic, with the potential to cause significant injury when ingested in toxic amounts. Although the antidote n-acetylcysteine (NAC) is available, evidence supporting dose recommendations for patients weighing over 100 kg are lacking. We performed a retrospective, multi-center analysis to determine if a capped NAC dosing scheme is similar to a non-capped dosing scheme in patients weighing over 100 kg.
Methods: Between January 2009 and January 2016, we identified patients presenting to 12 different centers who were evaluated for acetaminophen poisoning treatment. Patients must have weighed greater than 100 kg and were evaluated and identified as needing treatment for acetaminophen-related poisoning with NAC. The primary outcome was occurrence of hepatic injury, defined as an AST or ALT ≥ 100 IU/L. Secondary endpoints included number of drug-related adverse events, occurrence of hepatotoxicity, cumulative NAC dose, regimen cost, length of hospital and intensive care unit stays, and in-hospital mortality.
Results: There were 83 patients identified as meeting the pre-specified inclusion and exclusion criteria. A capped NAC dosing scheme resulted in no difference in hepatic injury when compared to a non-capped regimen (49.4% vs 50%, p = 1.000). The capped dosage regimen was associated with a lower cumulative dose (285.2 mg/kg vs 304.6 mg/kg, p < 0.001) and cost. No other statistically significant differences were identified among the secondary endpoints.
Conclusion: A capped NAC dosing scheme was not associated with higher rates of hepatic injury or hepatotoxicity in obese patients in the setting of acetaminophen poisoning when compared to a non-capped regimen. Further research is needed to verify these results.
التعليقات: Comment in: J Med Toxicol. 2022 Jan;18(1):65-66. (PMID: 35006546)
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فهرسة مساهمة: Investigator: AJ Dugan; L Atchison; KM DeWitt; MK Doolin; MA Howland; E Lingenfelter; T Neitzel; C Sloan; P Wong
Keywords: Acetaminophen; N-acetylcysteine; Obesity; Overdose; Toxicity
المشرفين على المادة: 0 (Analgesics, Non-Narcotic)
0 (Free Radical Scavengers)
362O9ITL9D (Acetaminophen)
WYQ7N0BPYC (Acetylcysteine)
تواريخ الأحداث: Date Created: 20210422 Date Completed: 20211111 Latest Revision: 20220716
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC8206426
DOI: 10.1007/s13181-021-00822-x
PMID: 33884558
قاعدة البيانات: MEDLINE
الوصف
تدمد:1937-6995
DOI:10.1007/s13181-021-00822-x